Low-Cost Method for Fixation of Distal Humerus Fracture in Elderly Osteoporotic Individuals: Experience from a Resource-Limited, Tertiary-Care Setting in North India

Abstract

Introduction: About 7% of adult fractures involve elbow and around 2% involve distal humerus. Conventionally, these are managed by ORIF with plates and screws. Often osteoporosis and communition of fracture fragments is observed in elderly presenting with this pattern of injury. This further complicates the situation for reconstruction and stable fixation which is critical for early mobilisation. We present our fixation method of Joshi’s External Stabilizing System resulting in satisfactory outcome Methods: During study period (August 2017-Oct 2019), total of 19 patients (male=8) were treated at Dr Rajendra Government Medical College, Tanda, Himachal Pradesh, India. Seventeen of them were elderly osteoporotic individuals. Closed reduction was achieved in 7 cases who had displaced supracondylar humerus fracture. Open reduction through triceps splitting approach extending longitudinally up to fascial sleeve of forearm was done in one case of one year old neglected supracondylar humerus fracture and all cases of intercondylar humerus fracture (N=9). Articular visualisation and reduction were achieved after flexing to about 110 degrees and applying longitudinal traction through trochlear notch with the help of ribbon gauge, obviating the need of olecranon osteotomy. Results: Union was achieved in 15 cases; one case was lost to follow-up after 8 weeks. Another case is within 4 weeks follow-up. Elbow movements were initiated on first post-operative day in all. Fracture was classified on basis of A.O classification. Mayo elbow performance score system was done to evaluate the final functional outcome (Table 1). Conclusion: Complications encountered include minor pin-tract infections in 6 patients. In one patient, fracture was noted on 5th post-operative day at proximal level of construct. This was the patient with one year old neglected supracondylar humerus fracture. One patient was lost to follow-up. Others are doing well after a follow-up duration of 218 patient-months.